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Query: UMLS:C0011881 (diabetic nephropathy)
 10,836 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Optimal metabolic control, strict antihypertensive therapy and a low-protein diet may reduce renal functional disorders such as hyperfiltration and microalbuminuria in the initial and latent phase of diabetic nephropathy and may retard progression of renal functional loss in the clinically-manifest proteinuric, azotaemic phase. Increasing clinical experience with renal replacement therapy in the end-stage renal failure of diabetic nephropathy led to a worldwide rise in the percentage of diabetic patients in dialysis centres. However, full rehabilitation is not achieved and retinopathy may progress to complete blindness. As a result of better rehabilitation and possible stabilisation of diabetic neuropathy and retinopathy after renal transplantation, in diabetic patients a kidney graft should be available early in the course of progressing renal failure.
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PMID:[Diabetic nephropathy--recent therapeutic concepts]. 218 81

We studied the possible association of the low serum uric acid level with incipient diabetic nephropathy in non-insulin-dependent diabetes mellitus (NIDDM). Of 201 NIDDM patients without a diminished glomerular filtration rate, 66 patients (32.8%) showed moderate hypouricemia of less than the mean-1 SD of 201 nondiabetic controls. Thirteen (6.5%) showed marked hypouricemia of less than the mean-2 SD. Hypouricemic patients showed normal daily urinary urate excretion with a markedly elevated urate clearance/creatinine clearance ratio. Most were under poor glycemic control, and presented either negative or intermittent clinical proteinuria. However, neither poor glycemic control, nor the presence of proteinuria or retinopathy alone significantly affected the serum uric acid level of the whole diabetic population. The glomerular filtration rate was determined in comparable groups of diabetic patients with hypouricemia and nonhypouricemic diabetic controls. The hypouricemic group showed a significantly higher endogenous creatinine clearance and lower serum beta-2-microglobulin levels than the nonhypouricemic group. These findings suggest that the hypouricemic group had a higher glomerular filtration rate. Long-term observation of up to 12 years of the above patients revealed that, in most patients, persistent hypouricemia was observed prior to the initial appearance of intermittent proteinuria. We hypothesize that glomerular hyperfiltration also occurs in NIDDM and that it lowers the serum uric acid by increasing the renal clearance of urate. Hypouricemia may also predict the future progression of incipient nephropathy in NIDDM.
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PMID:Diabetic hypouricemia as an indicator of clinical nephropathy. 219 Apr 67

Increasing prevalence of insulin-dependent diabetes in associated with a rise in organ complications, markedly increasing morbidity and mortality, especially those of young and middle-aged people. The key role in the etiopathogenesis of diabetic nephropathy, retinopathy and neuropathy is played by a metabolic disorder. The only procedure capable of restoring normal metabolism is replacement of damaged endocrine tissue, i.e., pancreas transplantation. A look back into the history, and a review of current concepts in experimental and clinical pancreases transplantation, highlight some questions to be solved, yet including prevention of the adverse effect of pancreatic hydrolytic enzymes, inhibition of the onset of thrombosis, and timely diagnosis of rejection. The currently employed techniques--pancreatic duct obliteration with polymer, intestinal and urinary bladder drainage of pancreatic secretion--yield approximately similar results. The technique of pancreas transplantation has not been refined to such an extent so as to enable its performance in the early stage of diabetes in a effort to prevent the onset of complications. Patients deriving most benefit from the technique are mainly uremic diabetics undergoing it in combination with renal transplantation which yields optimal results. While a renal graft allows improved detection of pancreas rejection, a pancreatic graft confers protection against recurrence of diabetic nephropathy. Simultaneous transplantation of both organs represents not only a life-saving procedure, it also offers appreciable improvement of the quality of life of the diabetic patient.
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PMID:Current concepts in pancreas transplantation. 219 14

We report a series of 33 consecutive hospitalized geriatric diabetic patients who were referred for evaluation of diabetic nephropathy, defined as proteinuria greater than or equal to 1 g/d (1,000 mg/24 h) or a serum creatinine concentration greater than or equal to 177 mumol/d (greater than or equal to 2 mg/dL). The study population was 60 years old or older (mean age, 68 +/- 6 years), was comprised mainly of women (24 of 33, 72.7%), and was predominantly black (25 of 33, 75.8%). All patients had type II diabetes. A family history of diabetes in parent or sibling was elicited in 24 (72.7%) patients. There were eight patients undergoing maintenance hemodialysis and 25 with less severe nephropathy (mean proteinuria, 2.7 g/d [2,700 mg/24 h]; mean creatinine clearance, 0.57 mL-s [34 mL/min]). Cardiac disorders were noted in the majority of patients: congestive failure in 20 (60.6%), myocardial infarction in eight (24.2%), and active angina in five (15.2%). Other comorbid diseases were present in both hemodialysis patients and the subset of nondialyzed azotemic-proteinuric patients, and consisted of peripheral neuropathy in 31 (93.9%), gastroparesis in 16 (48.5%), retinopathy in 28 (84.8%), and legal blindness in 11 (33%). We conclude that geriatric diabetic nephropathy in type II diabetes is similar in presentation and severity of comorbid extrarenal complications to the syndrome described in younger adults. This inference must be tempered by both the small size and the limitation imposed by the demographics of the study population, which is predominantly composed of black patients receiving treatment at inner city hospitals.
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PMID:Geriatric diabetic nephropathy: an analysis of renal referral in patients age 60 or older. 222 Jul 76

We report a case showing typical diabetic nodular glomerulosclerosis without retinopathy or other apparent clinical findings of DM except for impaired glucose tolerance. The 57-year-old man had a family history but no personal history of DM. In an extensive examination for DM, the results of funduscopy, daily profile of serum glucose and hemoglobin Alc were entirely within normal limits. However, the oral glucose tolerance test was abnormal. A renal biopsy showed typical nodular lesions (Kimmelstiel-Wilson's lesions). Previously, the interesting feature of transient proteinuria had been recognized. Although hypocellular nodular lesions by light microscopy are characteristic of diabetic nephropathy, renal amyloidosis, carbon disulfide intoxication, multiple myeloma and light chain disease, we concluded that the present lesions had resulted from diabetic nephropathy based on the family history, patient history, impaired glucose tolerance, immunofluorescent findings and electron microscopic observations.
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PMID:Nodular glomerulosclerosis in a patient showing impaired glucose tolerance. 225 Apr 5

Therapeutic considerations regarding the treatment of hypertension in patients with diabetes mellitus are reviewed. Good blood pressure control is essential in diabetic patients to prevent morbidity and mortality associated with cardiovascular diseases. Hypertension may also accelerate complications of diabetic microvascular disease, nephropathy, and retinopathy. Diuretics (e.g., thiazides, furosemide, ethacrynic acid, bumetanide) and beta blockers have traditionally been used as initial therapy for most patients with hypertension; however, these agents may not be the best choice for diabetics. Adverse metabolic consequences include alteration of glucose metabolism and plasma lipids. Beta blockers may also blunt the ability of patients to recognize symptoms of hypoglycemia. Both diuretics and beta blockers can cause sexual dysfunction in men. Adrenergic agents and vasodilators are associated with a high prevalence of orthostatic hypotension in diabetic patients. The calcium-channel blockers are considered safe and well tolerated when given at low and moderate doses. The angiotensin-converting-enzyme (ACE) inhibitors are able to slow the progression of diabetic nephropathy by reducing the glomerular hypertension that causes it. For the treatment of mild hypertension in diabetic patients, the drugs of choice should include (in descending order) ACE inhibitors, calcium-channel blockers, diuretics, and beta blockers. Severe or resistant hypertension usually requires treatment with combinations of drugs, including a diuretic. Tailoring therapy to individual complications and close monitoring of the patient are essential for safe, effective treatment of hypertension in the diabetic patient.
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PMID:Management of hypertension in the diabetic patient. 227 52

Successful pancreas transplantation can result in the longterm normalization of glucose metabolism. Since most pancreas recipients already have severe diabetic complications, and the observation period after transplantation is rather short, an assessment of the effect of complete glucose normalization on these diabetic changes is problematic. It has, however, been shown that the development of diabetic nephropathy can be prevented, peripheral microcirculation improved, and autonomic and peripheral neuropathy and retinopathy stabilized. These positive effects are, possibly, in part due to the elimination of uremia, since most patients receive both a pancreas and a kidney. The aim must be to perform pancreas transplantation in an early stage of diabetes, even though remarkable improvements have also been reported in terminal stages of the disease, and the quality of life of these patients has been significantly improved.
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PMID:[Pancreas transplantation in Type I diabetic patients]. 227 7

The dietary regimen of 70 patients with insulin dependent diabetes mellitus is discussed. 24 of these patients are with microalbuminuria (initial nephropathy). The age of manifestation of diabetes and the mean age of these patients are lower and the retinopathy is more frequent than in the patients without microalbuminuria. Only 18% of the diabetic patients studied keep a diet according to contemporary conceptions. In the group with initial nephropathy a higher consumption of fat (130.9 +/- 42.5 g) and proteins (109.6 +/- 28.8 g) is registered than in the other patients. There are no significant differences in the consumption of carbohydrates and fiber products. The possible role of longterm high consumption of fats and proteins by patients with diabetes mellitus in the pathogenesis of diabetic nephropathy is discussed.
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PMID:[Differences in the dietary intake of diabetics with and without early nephropathy]. 228 8

Excretion of epidermal growth factor (EGF) is decreased in renal failure. We assayed it in diabetes mellitus in an attempt to relate it to clinical parameters, esp. those of diabetic nephropathy. EGF excretion declined with age but in all age groups of diabetic patients was below the first percentile for controls. In 26 control and 34 prepubertal diabetic children excretion was correspondingly 1126 +/- 442 and 932 +/- 489 pmol/mmol creatinine (P = 0.087); in 26 control and 42 diabetic adolescents below age 18, 778 +/- 222 and 676 +/- 335 (P = 0.023) and in 81 control and 83 diabetic adults, 371 +/- 153 and 235 +/- 140 (P less than 0.0001). Decreased excretion of EGF was seen in some patients without any diabetic complications. Excretion of EGF was independently and inversely correlated with age and duration of diabetes but not with type of diabetes, treatment, body built, C-peptide, plasma glucose, glycohemoglobin or retinopathy. A positive correlation was seen with creatinine clearance and a negative correlation, with albuminuria, but the strongest and the only independent correlation found by stepwise multiple variable selection was with serum creatinine (r -0.711, P less than 0.0001). EGF excretion was not elevated in patients with hyperfiltration. We conclude that EGF excretion is abnormal in many patients with diabetes and that this abnormality reflects a kidney function different from glomerular filtration or glomerular permeability.
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PMID:Excretion of epidermal growth factor (EGF) in diabetes. 228 16

This study reviewed the histopathology of endometrial curettings following spontaneous abortion in diabetics and controls. The two groups did not differ significantly for an array of histologic features. The relationships between histopathology and diabetic White class, diabetic nephropathy or retinopathy, first trimester hemoglobin A1 percentage, and first trimester serum magnesium level were studied. The only significant correlation found was between diabetic retinopathy and decidual congestion with the presence of venous fibrin.
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PMID:Histopathology of spontaneous abortion in diabetic pregnancies. 237 25


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